ISSUED 12/2/19
The Department of Health and Human Services (HHS) recently announced its annual adjustments of civil monetary penalties in
accordance with a 2015 law requiring annual adjustments for inflation. These adjustments are effective for penalties assessed on or after November 5, 2019, for violations occurring on or after November 2, 2015.
Health Insurance Portability and Accountability Act (HIPAA) |
2019 |
2020 | |
Tier 1: Lack of Knowledge |
Min: $114 |
Min: $117 Max: $58,490 Year Cap: $1,754,698 | |
Max: $57,051 Year Cap: $1,711,533 | |||
Tier 2: Reasonable Cause and Not Willful Neglect |
Minimum: $1,141 |
Min: $1,170 Max: $58,490 Year Cap: $1,754,698 | |
Maximum: $57,051 Year Cap: $1,711,533 | |||
Tier 3: Willful Neglect, Corrected Within 30 Days |
Min: $11,410 |
Min: $11,698 Max: $58,490 Year Cap: $1,754,698 | |
Max: $57,051 Year Cap: $1,711,533 | |||
Tier 4: Willful Neglect, Not Corrected Within 30 Days |
Min: $57,051 |
Min: $58,490 Max: $1,754,698 | |
Max: $1,711,533 | |||
Summary of Benefits and Coverage (SBC) | 2019 | 2020 | |
Health insurer’s or non-federal governmental health plan’s willful failure to provide an SBC |
$1,128 |
$1,156 | |
Medicare Secondary Payer | 2019 | 2020 | |
Employer offers incentives to Medicare-eligible |
$9,239 |
$9,472 | |
individuals not to enroll in a plan that would otherwise | |||
be primary | |||
Employer fail to provide information identifying situations where group health plan is primary |
$1,181 |
$1,211 | |
Employer willfully or repeated failure to provide |
$1,504 |
$1,542 | |
requested information regarding group health plan | |||
coverage |
Employers should ensure they are compliant with Health Insurance Portability and Accountability Act (HIPAA), Medicare secondary payer
(MSP), and Summary of Benefits and Coverage (SBC) requirements as not to run the risk of being assessed these increased penalties.
Although these penalties have been in existence since 2015, the adjusted values can add up quickly and provide a strong incentive for compliance. To learn more about how the adjustments may impact your organization, reach out to your OneDigital consultant.